Research pain

RESEARCH ARTICLE Open Access

Knowledge, and use of labour pain relief
methods and associated factors among
obstetric caregivers at public health centers
of East Gojjam zone, Amhara region,
Ethiopia: a facility based cross- sectional
study
Keralem Anteneh Bishaw1*, Endalew Gemechu Sendo2 and Workinesh Sinshaw Abebe2

: The study was conducted in public health centers of East Gojjam Zone, Amhara region, Ethiopia. The
purpose of this study was to assess knowledge, and use of labour pain relief methods and associated factors
among obstetric caregivers in the study setting.

: A facility-based cross-sectional study design was conducted from March 1–30, 2018. The study was
conducted among three hundred and nine sampled obstetric caregivers. Structured questionnaire was used to
collect the data. The data were entered into Epi-data version 4.2 Software for cleaning and exported to SPSS
version 23.0 for data analysis. Multivariate logistic regression was carried out for variables with a p-value < 0.25 in bivariate logistic regression to determine significant relationships between the dependent and independent variables. Statistical significance was determined at 95% confidence interval (CI) and p-value below 0.05.

Result: The overall use of labour pain relief methods reported was 34.4%, (30.4% non-pharmacological and 8.4
pharmacological, respectively). More than half of the study participants (54.2%) had adequate knowledge about
labour pain relief methods. In multivariate analysis, being a midwifery profession [AOR =2.814, 95% CI = (1.574–
5.031)], having positive attitude [AOR = 4.370, 95% CI = (2.523–7.567)], and professionals with a medium level of
education [AOR = 3.450, 95% CI = (1.993–5.971)] were factors significantly associated with knowledge of obstetric
caregivers about labour pain relief methods. In multivariate analysis, knowledge of obstetric caregivers [AOR = 3.821,
95% CI = (2.091–6.980)], positive attitude of obstetric caregivers [AOR = 2.455, 95% CI = ((1.358–4.436))] and
experience of obstetric caregivers [AOR = 2.56, 95% CI = (1.350–4.845) were factors significantly associated with the
use of labour pain relief methods.

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* Correspondence: keralemante2010@gmail.Com
1Department of Midwifery, Debre-Markos University, College of Medicine and
Health Sciences, Debre-Markos, Ethiopia
Full list of author information is available at the end of the article

Bishaw et al. BMC Pregnancy and Childbirth (2020) 20:180
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: In this study, the overall use of labour pain relief methods by obstetric caregivers was low. Systemic
opioid (Pethdine) was reportedly one of the most known pharmacological pain relief methods in this study.
Providers’ knowledge, attitude and work experience had shown statistical significance with the use of labour pain
relief methods. Task-oriented in- service training is required to fortify obstetric caregivers’ knowledge and attitude
towards the use of labour pain relief methods.

Keywords: Knowledge, Labour pain relief methods, Obstetric caregivers, Ethiopia

Background

Pain accompanies a human being since the beginning of
his or her existence and is widely recognized as a nega-
tive phenomenon. In fact, it is an indispensable element
of our life. It signals the worsening of health (called
pathologic pain in that case), or it supports the progress
of natural processes taking place in the body, e.g. during
labour (physiological pain) [1].
Since creation, human beings have constantly felt pain

and have always tried to control it in different ways.
Labour pain is one of the most severe pains. This pain,
as one of the inevitable aspects of the childbirth process,
is unlike from other pains. It is not a sign of injury or
(tissue damage), reduces spontaneously, is regular and
continuous, gets tense gradually, and leads to a pleasant
incident, which is childbirth [2].
Pain during labour is a central part of women’s experi-

ence of childbirth, as its excruciating nature makes most
women want to alleviate it. Childbirth is among one of
the most intense pain that majority of women will en-
dure during their lifetime [3, 4]. Unresolved past psycho-
logical or physical distress along with loneness, lack of
knowledge, unfriendly or unresponsive treatment during
labour might surge the chance that the woman will suf-
fer. In sub-Saharan Africa particularly in Nigeria, giving
birth may not be an excited incident, however, it can be
an unhappiness experience owing to some midwives’ at-
titude towards the laboring woman who scream at
labouring woman mainly when she cries or complains of
labour pain [5].
Various pharmacologic and non-pharmacologic treat-

ments have been developed to alleviate the labour pains;
and their use has become popular, specifically in devel-
oped countries [6]. Pain relief during labour is desired
by many women, irrespective of race or belief, and con-
tributes enormously to their satisfaction with the experi-
ence of childbirth. Labour pain can be perceived to be
the most severe form of pain experienced in a woman’s
life. Studies have shown that when women are offered
analgesia during labour, they report greater satisfaction
with their overall birth experience [7, 8].
A study in Southeast Nigeria among Igbo women re-

ported 67.6% of labouring women need labor pain allevi-
ation, however, only 27% of parturient received pain

relief during labour [9]. Another study in Aga Khan
teaching and referral hospital in Kenya found that 90%
of woman would request some form of labour pain relief
at their next delivery but 18% had been offered some
form of pain relief at their last delivery with 82% of those
offered having effective pain relief as reported by the
study participants [10].
Although labor pain management is accepted and im-

plemented in many countries of the world, in Ethiopia
pain management during labor is not a common prac-
tice. This might be as a result of a number of factors:
the availability of drugs, health care delivery systems,
limited knowledge, providers’ attitude about labor pain
management, and choice of caregivers and clients. Of
these, the attitude, knowledge, and skills of the provider
to offer labour analgesia are vital, particularly in low-
income countries, including Ethiopia [11, 12]. Therefore,
this study aimed at assessing the level of knowledge, use
of labour pain relief methods and associated factors
among obstetric caregivers at public health centers of
East Gojjam Zone, Amhara Region, Ethiopia.

Methods
Study design
A facility-based cross-sectional study was conducted.

Study area and period
The study was conducted in public health centers of East
Gojjam Zone from March 1–30, 2018. East Gojjam is
one of an administrative zone in Amhara regional state
of Ethiopia. Debre Markos town is the capital city of
East Gojjam zone, which is 265 Km far from Bahirdar,
the capital city of Amhara region and 299 Km from
Addis Ababa, the capital city of Ethiopia. According to
2010 Health Bureau of East Gojjam Zone, there were
100 public health centers, and 329 health officers, 797
nurses and 307 midwives working in the zone (district).

Sample size, population and sampling technique
We selected thirty-three (33) public health centers (33%)
out of 100 public health centers located in the study area
by simple random sampling technique (lottery method).
The source population of the study was health profes-
sionals in public health centers of East Gojjam Zone,

Bishaw et al. BMC Pregnancy and Childbirth (2020) 20:180 Page 2 of 9

Amhara region, Ethiopia. The study population was ob-
stetric caregivers available during the study period in
sampled health centers. Three hundred and nine (309)
sampled obstetric caregivers; (including midwives,
nurses, and health officers) who were giving obstetric
care in the delivery room were consented and included
in the study. Health care providers came to labour ward
for consultation during study period were excluded from
the study. Since there were small numbers of study
population in the study area, all obstetric care caregivers,
who were available during the study period were consid-
ered as study participants.

Data collection tools and procedures
A Structured pretested self-administered questionnaire
was used to collect the data. The questionnaire was
adapted from reviewed literature [13–15], and with some
amendments into the local context. The questionnaire
consisted of seven parts: the first part was used to assess
socio-demographic characteristics of obstetric caregivers
while the rest were used to assess the knowledge, atti-
tude, use, preference of labour pain relief methods and
institutional factors affecting the use of labour pain relief
method. The questionnaire was designed in English to
be understood by every study participants. Nine diploma
nurses were recruited for data collection and two BSc
midwives were hired for the supervision of data collec-
tion procedure.

Measurement
Knowledge about labour pain relief methods were mea-
sured by a 10-item knowledge questionnaire adapted from
previous studies [13–15]. The scale for assessing knowledge
were from 0 to 10 scores. Correct answers were given a
score of 1 and incorrect answers 0. Those who scored less
than the mean value were considered to have inadequate
knowledge while those who scored greater than or equal to
the mean value were considered as having good knowledge.
Use of labor pain relief method was measured by the

following question: Obstetric care provider who an-
swered “yes” for the question “Have you ever provide
any labor pain relief method in the past one month? At-
titude towards labor pain relief method: A seven (7) item
response options (Yes/No) were adapted from prior
studies [13, 14]. The total score were computed for each
respondent and it ranges from 0 to 14 scores. Those
who score less than the mean value were considered to
have negative attitude while those who score greater
than or equal to the mean value were considered as hav-
ing positive attitude towards labour pain relief methods.

Data quality control
Training was provided for data collectors and supervi-
sors on objective, the benefit of the study, individual’s

right and informed consent for the common under-
standing of the study in general and the questionnaire in
particular. A pre – test was done in west Gojjam zone
public health centers on 5% of obstetric caregivers two
weeks before the actual data collection time. Regular
supervision during data collection was made; the ques-
tionnaire was reviewed and checked for completeness,
accuracy and consistency by the research team and
supervisors.

Data analysis
First, the questionnaire was checked for completeness.
The data were entered into Epi-data version 4.2 Software
for cleaning and exported to SPSS version 23.0 for data
analysis. Descriptive statistics were computed to deter-
mine frequencies and summary statistics (mean, stand-
ard deviation, and percentage) to describe the study
population in relation to socio-demographic and other
related variables. Bivariate logistic regression was carried
out to see the association of each of the independent
variables with the outcome variable. Multivariate logistic
regression was then carried out for variables with a p-
value < 0.25 to determine significant relationships between the dependent and independent variables. Stat- istical significance was determined at 95% confidence interval (CI) and p-value below 0.05.

Socio demographic characteristics of respondents
Out of the 309 sampled obstetric caregivers, 299
responded to the questionnaires making a response rate
of 96.8%. The mean age of the respondents was 28.96 (±
SD = 4.195) years. A significant number 194 (64.9%) of
them were in the age group of 20–29 years. More than
half 162 (54.2%) of the respondents were males and the
majority (86.6%) were Orthodox Christians. Out of the
total respondents, 31.1% were midwives by their profes-
sion. Nearly half 149 (49.8%) of study participants were
diploma holders and 49.2% of them had BSc degree.
Among the respondents (61.9%) had work experience of
less than 5 years (See Table 1).

Knowledge of study participants about labour pain relief
methods
Majority (94.3%) of respondents reported that they knew
about labour pain management methods in general, of
these 44 (14.7%) knew pharmacologic and 58 (19.4%)
knew non-pharmacologic labour pain relief methods
only. Nevertheless, 175 (58.5%) of them reported that
they knew both labour pain relief methods.
Among the study participants who knew pharmaco-

logic methods, 174 (79.5%) of them knew steroidal
drugs, 130 (59.4%) systemic opioid’s, 75 (34.2%) epidural
analgesia and 24 (11%) inhalational methods,

Bishaw et al. BMC Pregnancy and Childbirth (2020) 20:180 Page 3 of 9

respectively. Of all who knew about pharmacologic
labour pain management methods, 161 (73.5%) and 157
(71.7%) of them reported delay progress of labour and
fetal distress as a side effect of labour analgesia, respect-
ively (See Fig. 1).
One hundred fifty-five (51.8%) of respondents reported

that they knew a WHO pain ladder. Among the study
participants who knew non-pharmacologic labour pain
relief methods, psychotherapy 217 (93.1%), allow the
mother to ambulate 188 (80.7%), massage the back
175(75.1%), show the woman how to bear down 127
(54.5%) and allow companion of choice of labouring
woman 110 (47.2%) were the commonly reported non-
pharmacologic labour pain relief methods (See Table 2).
In this study, out of the total respondents more than

half (54.2%) of obstetric care providers had adequate
knowledge on listed types of labour relief methods (with

95% CI = 48.55–59.85%) while the rest 137 (45.8%) of re-
spondents had inadequate knowledge about the listed
labour pain relief methods.

Attitude towards labour pain relief methods
As regards the attitude of obstetric care givers towards
labour pain relief methods, more than half (57.2%) of
them had positive attitude whereas 42.8% of them had
negative attitude towards managing of labour pain. The
majority (86.3%) of the study participants believed man-
aging of labour could help labouring woman to cope
labour pain. However, 55.9% of them thought that
pharmacologic labour pain relief method (analgesic) is
not required for managing such labour pain.

Use of labour pain relief methods
The result of this study showed that the overall use of
labour pain relief methods among obstetric caregivers
was reported as 34.4% (30.4% non-pharmacologic and
8.4% pharmacologic pain relief methods) with 95% confi-
dence interval of [29.01–39.78], respectively. From the
non-pharmacologic labour pain management methods,
psychotherapy was the most widely used method, which
was prescribed by 132 (44.2%) of obstetric caregivers
followed by massaging the back 122(40.8%) (See
Table 3).

Personal preference and pain expectation
From the total study participants, most obstetric care-
givers (87.6%) expected labour pain as severe pain while
(3.4%) of them expected labour pain as moderate pain.
Among the study participants, more than half (55.9%)
preferred non-pharmacologic methods while 10.7% of
them preferred pharmacologic methods to manage
labour pain, respectively. Diclofenac (51.2%) was the
highest reported preferred pharmacologic method
followed by pethdine (34.1%).

Reasons for non-utilization of labour pain relief methods
The most common reasons reported for non-utilization
of labour pain relief methods were high patient flow 131
(43.8%) followed by unavailability of drugs 124(41.5%),
respectively (See Fig. 2).
Of those who knew pharmacologic methods, 153

(51.2%), 140 (46.8%), 102 (34.1%) and 93 (31.1%) of
study participants reported diclofenac, Paracetamol,
Pethidine and Hyoscine were available in their health
centers for use, respectively. Eighty-seven (29.1%) of
study participants reported companion as a choice for
labouring woman is not allowed by their health center
and 87% of them reported that they didn’t get any spe-
cial training on labour pain management.

Table 1 Socio-demographic characteristic of obstetric
caregivers working at labour ward in public health centers of
east Gojjam zone, Amhara region, Ethiopia, 2018 G.C. (N = 299)

Characteristics Frequency (n) Percent (%)

Age (in years)

20–29 194 64.9

30–39 97 32.4

≥ 40 8 2.7

Mean age: 28.96
(± SD = 4.195)

Gender

Male 162 54.2

Female 137 45.8

Religion

Orthodox 258 86.3

Muslim 30 10

Protestant 10 3.4

Other© 1 0.3

Profession

Health officer 75 25.1

Midwife 93 31.1

Nurse 131 43.8

Level of education

Diploma 149 49.8

BSc degree 147 49.2

Masters 3 1

Clinical experience (in years)

≤ 5 185 61.9

6–9 76 25.4

≥ 10 38 12.7

Other© = Catholic

Bishaw et al. BMC Pregnancy and Childbirth (2020) 20:180 Page 4 of 9

Factors associated with knowledge of obstetric caregivers
towards labour pain relief methods
Profession categories, staff attitude, level of education,
and companionship were significantly associated with

knowledge of obstetric caregivers about labour pain re-
lief methods in bivariate logistic regression. These vari-
ables also remained significantly associated in
multivariable logistic regression. Being midwifery profes-
sionals were 2.8 times more likely to be knowledgeable
about labour pain relief methods than health officer and
nurses. [AOR =2.814, 95% CI = (1.574–5.031)]. Profes-
sionals with a medium level of education were 3.45
times more likely to be knowledgeable about labour pain
relief methods compared to those with a lower level of
education [AOR = 3.450, 95% CI = (1.993–5.971)]. Ob-
stetric caregivers who had a positive attitude about

Table 2 Knowledge of obstetric caregivers on Non –
pharmacologic labour pain relief methods working at labour
ward in public health centers of east Gojjam zone, Amhara
region, Ethiopia, 2018 G.C. (n = 233)

Types Frequency (n) Percent (%)

Psychotherapy Yes 217 93.1

No 16 6.9

Allow the mother to ambulate Yes 188 80.7

No 45 19.3

Massage the back Yes 175 75.1

No 58 24.9

Allow free vertical positioning Yes 61 26.2

No 162 73.8

Transcutaneous electrical
nerve stimulation

Yes 13 5.6

No 220 94.4

Show the woman how to bear down Yes 127 54.5

No 106 45.5

Acupuncture Yes 20 8.6

No 213 91.4

Hypnosis Yes 13 5.6

No 220 94.4

Allow companion of labouring
woman choice

Yes 110 47.2

No 123 53.8

Music therapy Yes 42 18

No 181 82

Table 3 Non -pharmacologic methods use by obstetric
caregivers working at labour ward in public health centers of
east Gojjam zone, Amhara region, Ethiopia, 2018 G.C. (n = 299)

Types Frequency (n) Percent (%)

Psychotherapy Yes 132 44.1

No 167 55.9

Allow the mother to ambulate Yes 116 38.8

No 183 61.2

Massage the back Yes 122 40.8

No 177 59.2

Allow free vertical positioning Yes 25 8.4

No 274 91.6

Show the woman how to bear down Yes 96 32.1

No 203 67.9

Hot compress Yes 7 2.3

No 292 97.7

Allow companion of her choice Yes 87 29.1

No 212 70.9

Fig. 1 Knowledge of obstetric caregivers on side effect of pharmacologic labour pain relief methods working at labour ward in public health
centers of east Gojjam zone, Amhara region, Ethiopia, 2018 (n = 219)

Bishaw et al. BMC Pregnancy and Childbirth (2020) 20:180 Page 5 of 9

labour pain management were 4.37 times more likely to
be knowledgeable about labour pain management
methods than those who had a negative attitude for
labour pain management [AOR = 4.370, 95% CI =
(2.523–7.567)] (See Table 4).

Factors associated with use of labour pain relief methods
Bivariate logistic regression revealed that professional
categories, knowledge, attitude, experience of obstetric
caregivers and allowing a companion for a labouring
woman were associated with the use of labour pain relief
methods. But only knowledge, attitude and experience of
obstetric caregivers remained significantly associated
with the use of labour pain relief methods for labouring

woman in multivariable logistic regression. Obstetric
caregivers who had adequate knowledge about labour
pain relief methods for managing labour pain were about
3.82 times more likely to use labour pain relief methods
than to those obstetric caregivers who had inadequate
knowledge about labour pain relief methods [AOR =
3.821, 95% CI = (2.091–6.980)].
Obstetric caregivers who had a positive attitude for

managing labour pain were 2.45 times more likely to use
labour pain management methods than those who had a
negative attitude for labour pain management [AOR =
2.455, 95% CI = ((1.358–4.436))]. Obstetric caregivers
who had an experience of 6–9 years and ≥ 10 years were
2.56 and 2.50 more likely to use labour pain relief

Fig. 2 Bar chart showing reasons for non-utilization of labour pain relief methods, 2018. (n = 299). Key: Other reasons: Free of side effect and
labour pain is a natural process which should not be managed

Table 4 Bivariate and Multivariate analysis of factors associated with knowledge of obstetric caregivers towards labour pain relief
methods east Gojjam zone, Amhara regional state, in Ethiopia, 2018. G.C. (n = 299)

Knowledge of obstetric caregivers COR (95% CI) AOR (95% CI) P Value

Characteristics Adequate inadequate

Frequency (n) Frequency (n)

Profession

Midwife 66(71%) 27(29%) 2.801(1.68–4.73) 2.814(1.574–5.031) .000

Others 96(46.6%) 110(53.4%) 1.00 1.00

Level of education

Lower 68 (43.6%) 88(56.4%) 1.00 1.00

Medium 94(65.7%) 49(34.3%) 2.483(1.55–3.97) 3.450(1.993–5.971) .000

Companion

Yes 132 (62.3%) 80(37.7%) 3.135(1.86–5.28) 2.349(1.314–4.197) .004

No 30(34.5%) 57 (65.5%) 1.00 1.00

Attitude

Favorable attitude 118(69%) 53(31%) 4.250(2.61–6.92) 4.370(2.523–7.567) 0.000

Un Favorable attitude 44(34.4%) 84(65.6%) 1.00 1.00

Lower level: Diploma; Mid-level: BSc holders; Others: Health officers & Nurses

Bishaw et al. BMC Pregnancy and Childbirth (2020) 20:180 Page 6 of 9

methods than those who have ≤5 years’ experience
[AOR = 2.56,95% CI = (1.350–4.845) and [AOR = 2.50,
95% CI = (1.132–5.524)], respectively (See Table 5).

The current study aimed to assess knowledge and use of
labour pain relief methods and associated factors among
obstetric caregivers at public health centers of East Goj-
jam Zone, Amhara region, Ethiopia.

Knowledge of obstetric caregivers towards labour pain
relief methods
In this study, systemic opioid (Pethdine) was reportedly
one of the most identified pharmacological pain relief
methods, which is similar with studies from Zaria,
Greek, and Ibadan (Nigeria), respectively [6, 16, 17]. This
might be due to accessibility and low cost of the drug on
the market. The present study showed that 45.8% of ob-
stetric caregivers had inadequate knowledge about
labour pain relief methods. Our finding is lower than the
findings reported from Tigray, Ethiopia (60.1%)
and Ibadan, Nigeria (66.7%), respectively [13, 17]. This
difference might be explained in terms of difference in
study setting and socio- demographic characteristics of
study participants. The study also found that midwifery
professionals had adequate knowledge than health offi-
cer and nurses, which was similar with Australian stud-
ies undertaken by Lee et al (2012) [18], which reported

knowledge as a significant factor for obstetric analgesia
use. In our study, professionals with a medium level of
education were 3.4 times more likely to be
knowledgeable than those with a lower level of educa-
tion regarding labour pain relief methods. This might be
explained in terms of variation in curriculum content of
obstetric courses delivered to health professions based
on their level of training programs. Positive attitude of
staff also showed significant association with knowledge
with regard to labour pain relief methods.

Use of labour pain relief methods among obstetric
caregivers
The current study showed that the overall use of labour
pain relief methods among obstetric caregivers was re-
ported to be 34.4% (30.4% non-pharmacological and
8.4% pharmacological) methods, respectively. This find-
ing is inconsistent with earlier studies’ findings from dif-
ferent parts of Ethiopia: Tigray, 43.3% [13], Addis
Ababa, 47.5% [19] and Amhara, 40.1% [14]. The reasons
might be the preceding studies were conducted in public
hospitals where better knowledge of labour pain relief
methods and drug availability are potentially high.
In our study, the use of non-pharmacological methods

was consistent with studies done in Dhaka, Bangladesh
and Ghana where allowing laboring woman to move
freely, showing the patient how to bear down, allowing
companion, and massaging the back were the most

Table 5 Bivariate and Multivariate analysis of factors associated with use of labour pain relief methods among obstetric caregivers
east Gojjam zone, Amhara regional state, in Ethiopia, 2018G.C.(n = 299)

Use of labour pain relief methods COR (95% CI) AOR (95% CI) P Value

Variables Yes No

Frequency (n) Frequency (n)

Profession

Midwife 40(44%) 53(56%) 1.713(1.032–2.842) 1.435(.801–2.572) .225

Others 63(70.4%) 143(29.6%) 1.00 1.00

Experience

≤ 5 years 52(28.1%) 133(71.9%) 1.00 1.00

6–9 years 32(42.1%) 44(57.9%) 1.860(1.066–3.246) 2.56(1.350–4.845) .004*

≥ 10 year 19(50%) 19(50%) 2.558(1.255–5.213) 2.50(1.132–5.524) .023*

Knowledge

Inadequate 22(16.1%) 115(83.9%) 1.00 1.00

Adequate 81(50%) 81(50%) 5.227(3.015–9.063) 3.82(2.091–6.980) .000*

Attitude

Favorable attitude 79(46.2%) 92 (53.8%) 3.721(2.177–6.360) 2.46(1.358–4.436) .000*

Un Favorable attitude 24(18.8%) 104(81.2%) 1.00 1.00

Companion

Yes 84(39.6%) 128(60.3%) 2.349(1.317–4.188) 1.458(.761–2.793) .256

No 19(21.8%) 68(78.2%) 1.00 1.00

Lower level: Diploma; Mid-level: BSc holders; Others: Health officers & Nurses

Bishaw et al. BMC Pregnancy and Childbirth (2020) 20:180 Page 7 of 9

applied non-pharmacologic pain relief methods [20, 21].
This study found that the use of pharmacologic labour
pain relief method by obstetric caregivers was reported
to be 8.4% of which pethidine, diclofenac, paracetamol
and Hyoscine were mostly used. This result is consistent
with studies done in Bangladesh and Ghana, where these
drugs were also used as pharmacological labour pain re-
lief methods [20, 21].
On the other hand, this result is higher than the find-

ings from studies done in Amhara region referral hos-
pital [14] and Tigray region general hospital [13]. This
might be due to time difference related to previous stud-
ies and increased awareness of obstetric caregivers
towards labour pain management through time. None-
theless, this result is found to be lower than the findings
from Nigeria, 49% [3], Kenya, 18% [8] and Addis Ababa
Ethiopia, 54.2% [19], respectively.
This study revealed that obstetric caregivers who had a

positive attitude for managing labor pain were 2.45 times
more likely to use labor pain management methods than
those who had a negative attitude for labour pain man-
agement [AOR = 2.455, 95% CI = ((1.358–4.436))]. This
finding is consistent with a study done in Bangladesh
[20], and Ethiopia [15], respectively.
In this study, obstetric caregivers who had adequate

knowledge about labour pain relief methods for man-
aging labour pain were 3.82 times more likely to use
labour pain relief methods than those who had inad-
equate knowledge about labour pain relief methods
[AOR = 3.821, 95% CI = (2.091–6.980)], which is incon-
sistent with studies from Nigeria and Abha Maternity
Hospital in Saudi Arabia where health care providers
who had adequate knowledge were more likely to pro-
vide labour relief method for labouring woman [17, 22].
The current study reported that obstetric caregivers

who had an experience of 6–9 and ≥ 10 years were more
likely to use labour pain relief methods than those who
had ≤5 years’ experience [AOR = 2.56,95% CI = (1.350–
4.845) and [AOR = 2.50,95% CI = (1.132–5.524), respect-
ively. This finding is similar to a study done in the U.S
where more experienced nurses provide more labour
support [23]. In this study, high patient flow, small num-
ber of staff, lack of knowledge, limited skill and unavail-
ability of equipment and drugs for managing labour pain
were factors affecting the use of labour pain relief
methods. This finding is also consistent with a study
done in Tigray region general hospitals, Ethiopia [13],
Amhara region referral hospitals, [14], Addis Ababa,
Ethiopia [19], Zaria, Nigeria [6] and Saudi Arabia [22].

Limitation of the study
The results of this study must be interpreted in the light
of the following limitations. The study was conducted in
public health centers of Amhara Region, Ethiopia. The

perspectives of health providers in private health facil-
ities were not explored in the study. The findings of this
study are thus mainly applied to obstetric care providers
in the study setting. Since the study was cross sectional
study, it did not address the cause and effect relationship
of the factors and the outcome variables.

Conclusion
Although labor pain management is accepted and imple-
mented in many countries of the world, pain manage-
ment during labor is not often practiced. This study is
essential as it aims to assess knowledge, and use of
labour pain relief methods and associated factors among
obstetric caregivers in this study area of Ethiopia.
The current study revealed that the overall use of labour

pain by obstetric caregivers was low. Systemic opioid
(Pethdine) was reportedly one of the most known
pharmacological pain relief methods in this study. Pro-
viders’ knowledge, attitude and work experience had
shown statistical significance with the use of labour pain
relief methods. Task-oriented in- service training is thus
required to fortify obstetric caregivers’ knowledge and atti-
tude towards the use of labour pain relief methods. Regu-
lar supervision of obstetric caregivers and logistic supplies
and analgesic drugs are also needed for effective labour
pain management. Furthermore, researchers in the field
are recommended to examine the use of labour pain relief
methods from maternal’ request point of view.
Overall, this is a fascinating study which has the poten-

tial to provide cross cultural education of caregivers from
a high income countries who might be caring for immi-
grant women from low income countries, and may also be
a very useful reference for planners of obstetric and mid-
wifery care and education in low income countries.

AOR: Adjusted Odds Ratio; CI: Confidence Interval; COR: Crude Odd Ratio;
HCP: Health Care Providers; OCGs: Obstetric Caregivers; SPSS: Statistical
Package for Social Sciences

We are indebted to Addis Ababa University, College of Health Sciences,
School of Nursing and Midwifery for its financial and technical support. We
are also very grateful to express our gratitude to East Gojjam Health Bureau
and the District health office for their kind assistance during the entire
process of the study. The authors are also grateful to the respondents who
participated in this study. Special thanks go to the research assistants who
participated in data collection.

Bishaw, KA conceptualized the proposal, searched literature, trained field
researchers for data collection and wrote the results and discussion sections.
He also drafts the first manuscript. Sendo, EG & Abebe, WS contributed to
the design of the study and provided advice as regards methods, data
interpretation and analysis. Sendo, EG also critically reviewed and edited the
manuscript. All authors read and approved the final manuscript.

Funding for this study was made possible through students’ grants offered
by Addis Ababa University post graduate office. Small grant is given for

Bishaw et al. BMC Pregnancy and Childbirth (2020) 20:180 Page 8 of 9

postgraduate students to cover their expenses for data collectors and
stationary. No other grants received for the study.

All the data included in the manuscript can be accessed from the
corresponding author with an email address keralemante2010@gmail.com

Ethical approval was obtained from Addis-Ababa University and permission
letter was secured from East Gojjam zone Health Bureau. Written informed
consent was obtained from respondents after giving them information about
the study. Finally, the confidentiality, anonymity of all the responses was kept
and used only for research purposes.

Not applicable

The authors declare that they have no competing interests.

1Department of Midwifery, Debre-Markos University, College of Medicine and
Health Sciences, Debre-Markos, Ethiopia. 2School of Nursing and Midwifery,
Addis-Ababa University, College of Health Science, Addis Ababa, Ethiopia.

Received: 17 December 2018 Accepted: 26 February 2020

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mailto:keralemante2010@gmail.com

Abstract

Background

Methods

Result

Conclusion

Background

Methods

Study design

Study area and period

Sample size, population and sampling technique

Data collection tools and procedures

Measurement

Data quality control

Data analysis

Results

Socio demographic characteristics of respondents

Knowledge of study participants about labour pain relief methods

Attitude towards labour pain relief methods

Use of labour pain relief methods

Personal preference and pain expectation

Reasons for non-utilization of labour pain relief methods

Factors associated with knowledge of obstetric caregivers towards labour pain relief methods

Factors associated with use of labour pain relief methods

Discussion

Knowledge of obstetric caregivers towards labour pain relief methods

Use of labour pain relief methods among obstetric caregivers

Limitation of the study

Conclusion

Abbreviations

Acknowledgements

Authors’ contributions

Funding

Availability of data and materials

Ethics approval and consent to participate

Consent for publication

Competing interests

Author details

References

Publisher’s Note

Summarize the article you read in your own words. Assess the article in the manner described in the video.

To do this, dissect the article into parts described in the video:

· Title

· Abstract

· Introduction

· Method

· Results

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· References.

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